History has a habit of repeating itself—especially in women’s health. Postpartum mental health took decades to get our attention. Perimenopause and menopause can’t wait that long

By: Autumn Backhaus, PhD

We’ve seen this before.

Postpartum women came in describing emotional chaos: Anxiety, rage, disconnection, panic, insomnia, sadness. Obsessiveness. Extreme fears. Shame.

We either: Brushed it off as baby blues—a “normal” part of adjusting to motherhood[1], or Diagnosed it using simplified, standard psychiatric categories.

In both cases, we missed the mark. We misunderstood what was happening because we ignored the hormonal transition at the center of it all. Perhaps even more concerning: women felt we minimized and dismissed their lived experiences—experiences that often required real support or treatment.

And now? We’re doing the exact same thing to perimenopausal and menopausal women.

We’re Missing It Again.

Perimenopausal and menopausal women are showing up in our offices with emotional, cognitive, and physiological symptoms that don’t fit neatly into standard psychiatric categories.

And once again, we’re defaulting to two responses: Brushed it off as “just getting older” Diagnose it using simplified, standard psychiatric categories—potentially pathologizing experiences without considering what’s happening hormonally.

We are mis-screening. We are mis-diagnosing We are mistreating. We are making women feel either dismissed or “crazy”—with no real framework for understanding why this is happening now.

And that’s a clinical failure.

What We Eventually Did Better in Postpartum Care

We began to recognize that symptoms experienced in the context of hormonal transition often present differently—and require a different level of understanding and attention.

We learned that there wasn’t just one postpartum experience—and that many of the most distressing ones weren’t being picked up by our existing tools. Studies eventually showed that many postpartum women with significant distress weren’t being identified by traditional screeners or diagnostic models[2].

We created better screening methods, like the Edinburgh Postnatal Depression Scale[3], because tools like the PHQ-9 were missing key patterns. We documented how many women presented with delayed onset or atypical symptoms. We started screening more routinely—supported by ACOG guidance[4].

We started to understand that what we had dismissed as “normal” adjustment were often women’s real, distressing experiences—deserving of validation, support, and clinical responsiveness.

Most importantly, we finally stopped treating distress during reproductive transitions as either nothing or purely psychiatric. We acknowledged the hormonal drivers—and the fact that they matter, a lot.

It’s Time to Course-Correct—Faster This Time

What we learned in the postpartum space must now be applied to perimenopause and menopause. And one thing is crucial: Many of the symptoms women report during this transition may not indicate psychiatric disorders at all.

Sometimes the symptoms are entirely hormone-fueled.

Sometimes they do reflect a mental health disorder.

Sometimes, it’s both.

When distress emerges during a hormonal transition, we need a different lens. We need training that helps clinicians recognize the nuanced complexities of when symptoms are biological in origin—not just emotional, environmental, or psychiatric in isolation.

We need tools that go beyond generalized symptom checklists. We need frameworks that ask the right questions and draw the right conclusions.

Let’s not take another 20 years to get this right. Let’s stop missing perimenopausal and menopausal women the way we once missed postpartum women. Let’s do better.

References: Brockington, IF. (2004). Postpartum psychiatric disorders. The Lancet, 363(9405), 303–310. Wisner KL, Sit DK, et al. (2013). Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings. JAMA Psychiatry, 70(5): 490–498. Cox JL, Holden JM, Sagovsky R. (1987). Development of the 10-item Edinburgh Postnatal Depression Scale (EPDS). Br J Psychiatry, 150:782–786. ACOG Committee Opinion No. 757 (2018). Screening for Perinatal Depression. Obstet Gynecol, 132(5):e208–e212.